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| 1 | Lumpsum items for CMAAY/ AB PM-JAY schemes to be quoted per annum |
| 2 | Setting up a State Project Office (SPO) at ICR with full team including state coordinator, IT coordinator, claim processing team, doctors etc. Refer Schedule 9 of draft contract. |
| 3 | Professional fee for maintenance of existing website and IT platforms of CMAAY including change request and/or management of customized TMS platform for CMAAY. |
| 4 | Processing of pre-authorization requests related to the hospitalisation services as per defined packages from EHCPs. Scrutiny and approval of preauthorization requests if all the conditions are fulfilled, within stipulated hours of receiving the preauthorization requests from the network hospitals as per the guideline. |
| 5 | Processing of claims i.e. scrutinize the bills from the empanelled hospitals (i.e. ensuring charges are as per the package rates) and give approval for the sanction of the bill and forward it to the State Health Agency CMAA Society for payment within 7 working days of receipt of the bills from the empanelled hospitals. |
| 6 | Fee for setting up of 24x7 Call Centre with a dedicated Call Centre Manager and minimum of 5 Call Centre Executives with ConVox Customer Relationship Management Software. |
| 7 | Management of Information System to ensure free flow of daily MIS & ensure that progress of the schemes is reported to SHA (for CMAAY & AB PM-JAY) in the desired format on a real-time basis. |
| 8 | Providing Medical auditors (a team of doctors and specialists with relevant specializations) for conducting concurrent audits of services delivered and medical facilities available in EHCPs. Claim audits, medical audits and beneficiary audits are conducted as per the stipulated numbers in the agreement-1. Claim audits- 10 % of total claims of the quarter2. Medical audits- 10% of total hospitalization cases per quarter.3. Medical audits- 100 % death audits.4. beneficiary audit on phone- 10% of total hospitalized beneficiaries in that quarter.(Other KPI as per ‘Schedule 8’ of draft contract) |
| 9 | Support in hospital empanelment related activities including field verification of the hospitals within and outside the state their training and related activities. |
| 10 | Fee for organizing physical capacity building/training programmes as per guidance by SHA and NHA in all thematic areas (core programme areas, IT tools and platforms, Audit &compliance, operations and management) inclusive of food & refreshment, boarding& lodging, travel, stationary, honorarium for resources person etc.) for a batch of 30 person. |
| 11 | Price to be quoted for each unit/event |
| 12 | Enrolment & verification of beneficiary family as per target population under CMAAY/Aadhaar eKYC of entitled beneficiary under AB PM-JAY. |
| 13 | Provide human resource as mentioned in the draft contract schedule 9: -Selection, training, deployment, monitoring & evaluation of District Programme Coordinator (DPC) in every district of Arunachal Pradesh and atleast one each in Dibrugarh, Guwahati, Shillong, New Delhi, Mumbai and Vellore as per the requisition by SHA based on caseload. MSP must comply statutory minimum wage set by the State Government. There would be no increase in rates payable to MSP during the contract period. However, if the minimum wage exceeds shall be reimbursed. |
| 14 | Provide human resource as mentioned in the draft contract schedule 9: -Selection, training, deployment, monitoring & evaluation of Arogya Mitra in every empanelled hospital as per the requisition by SHA based on caseload. MSP must comply statutory minimum wage set by the State Government. There would be no increase in rates payable to MSP during the contract period. However, if the minimum statutory wage exceeds the wage quoted under this section due to revision by the Govt. of Arunachal Pradesh, the difference by which the minimum wage exceeds shall be reimbursed. |
| 15 | Provide Mobile handsets and pay monthly service charges for CUG connections to all Arogya Mitra and District Programme Coordinators. |
